CSF, you should not be here! How to recognize CSF leak in CT-cisternography and CT-myelography images

Cerebrospinal fluid (CSF) rhinorrhea after acoustic neuroma surgery is a well-known complication. CT cisternography can be used to demonstrate the entry of CSF from cerebellopontine angle cistern into the mastoid air cells, middle ear and then into nasopharynx via Eustachian tube. We report a case of paradoxical CSF rhinorrhea after surgery for acoustic neuroma in which the path of CSF leak was accurately demonstrated using CT cisternography.

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Endoscopic Management of Meningoencephaloceles and other Cranial Base Defects using Septal Cartilage

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1155 ◽

2013 ◽

Vol 6 (2) ◽

pp. 67-71

Author(s):

Nishi Sonkhya ◽

Divij Sonkhya

Keyword(s):

Case Series ◽

Cranial Base ◽

Septal Cartilage ◽

Endoscopic Examination ◽

Csf Leak ◽

Endoscopic Management ◽

Ct Cisternography ◽

Medical College ◽

Computed Tomographic ◽

Magnetic Resonance Imaging Mri

ABSTRACT Objective To study and analyze 40 cases managed endoscopically of meningoencephaloceles and other cranial base defects using septal cartilage. Design Prospective, interventional case series. Materials and methods This study was conducted in the Department of Otorhinolaryngology SMS Medical College from 2006 to 2011. The study consisted of evaluations of self-reported and referred patients who presented to ENT OPD and emergency. In all the cases a detailed history and clinical examination was done. All the patients underwent nasal endoscopic examination. Computed tomographic (CT) scans were obtained for all cases. Magnetic resonance imaging (MRI) and CT cisternography was done in some of the cases. Results Success of the treatment was defined as resolution of symptoms, stoppage of leak, no recurrence, no complication and regular follow-up. A total of 40 cases were managed between 2006 and 2011 and were reviewed. The main presentation was of cerebrospinal fluid (CSF) leak in 22 cases with most common cause being traumatic. Fovea ethmoidalis being the most common site involved in 19 cases. Conclusion Endoscopic repair is the most modern and best result-oriented tool in the armamentarium of a surgeon to handle CSF leaks and with use of septal cartilage the results are less burdened with recurrences and failures. How to cite this article Mehta R, Sonkhya D, Sonkhya N . Endoscopic Management of Meningoencephaloceles and other Cranial Base Defects using Septal Cartilage. Clin Rhinol An Int J 2013;6(2):67-71.

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Prevalence of hyperdense paraspinal vein sign in patients with spontaneous intracranial hypotension without dural CSF leak on standard CT myelography

Diagnostic and Interventional Radiology ◽

10.5152/dir.2017.17220 ◽

2018 ◽

Vol 24 (1) ◽

pp. 54-59 ◽

Cited By ~ 10

Author(s):

Michael S. Clark ◽

Felix E. Diehn ◽

Jared T. Verdoorn ◽

Vance T. Lehman ◽

Greta B. Liebo ◽

...

Keyword(s):

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Csf Leak ◽

Ct Myelography

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Recurrent subdural hematoma caused by cerebrospinal fluid leakage

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.2.183 ◽

2006 ◽

Vol 4 (2) ◽

pp. 183-185 ◽

Cited By ~ 12

Author(s):

Junichi Mizuno ◽

Praveen V. Mummaneni ◽

Gerald E. Rodts ◽

Daniel L. Barrow

Keyword(s):

Cerebrospinal Fluid ◽

Computerized Tomography ◽

Subdural Hematoma ◽

Nerve Root ◽

Csf Leak ◽

Cerebrospinal Fluid Leakage ◽

Dural Defect ◽

Ct Myelography ◽

Csf Fistula ◽

Csf Leakage

✓The authors report a case of a recurrent subdural hematoma (SDH) that was caused by a persistent cerebrospinal fluid (CSF) leak from an L1–2 fistula. A 34-year-old man experienced severe headaches due to SDH, and he underwent aspiration of subdural fluid four times due to recurrent collections. Further evaluation with computerized tomography (CT) myelography demonstrated extradural extravasation of contrast through an L1–2 fistula. The patient underwent an L1–2 laminectomy; a small dural defect with CSF leakage at the left nerve root sleeve was found and was repaired. Following the repair, the patient had no further recurrence of SDH. Recurrent SDH, caused by spontaneous CSF leakage through a lumbar CSF fistula, is extremely rare. In cases of recurrent SDH, radiographic workup with spinal CT myelography should be considered.

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Ultrafast dynamic computed tomography myelography for the precise identification of high-flow cerebrospinal fluid leaks caused by spiculated spinal osteophytes

Journal of Neurosurgery Spine ◽

10.3171/2014.10.spine14209 ◽

2015 ◽

Vol 22 (3) ◽

pp. 324-331 ◽

Cited By ~ 26

Author(s):

Kent R. Thielen ◽

John C. Sillery ◽

Jonathan M. Morris ◽

Joseph M. Hoxworth ◽

Felix E. Diehn ◽

...

Keyword(s):

High Flow ◽

Csf Leak ◽

Precise Localization ◽

Dynamic Ct ◽

Ct Myelography ◽

Ultrafast Dynamic ◽

Adjacent Structures ◽

Digital Subtraction Myelography ◽

Relationship Of ◽

Csf Leaks

OBJECT Precise localization and understanding of the origin of spontaneous high-flow spinal CSF leaks is required prior to targeted treatment. This study demonstrates the utility of ultrafast dynamic CT myelography for the precise localization of high-flow CSF leaks caused by spiculated spinal osteophytes. METHODS This study reports a series of 14 patients with high-flow CSF leaks caused by spiculated spinal osteophytes who underwent ultrafast dynamic CT myelography between March 2009 and December 2010. There were 10 male and 4 female patients, with an average age of 49 years (range 37–74 years). The value of ultrafast dynamic CT myelography in depicting the CSF leak site was qualitatively assessed. RESULTS In all 14 patients, ultrafast dynamic CT myelography was technically successful at precisely demonstrating the site of the CSF leak, the causative spiculated osteophyte piercing the dura, and the relationship of the implicated osteophyte to adjacent structures. Leak sites included 3 cervical, 11 thoracic, and 0 lumbar levels, with 86% of the leaks occurring from C-5 to T-7. Information obtained from the ultrafast dynamic CT myelogram was considered useful in all treated CSF leaks. CONCLUSIONS Spinal osteophytes piercing the dura are a more frequent cause of high-flow CSF leaks than previously recognized. Ultrafast dynamic CT myelography adds value beyond standard dynamic myelography or digital subtraction myelography in the diagnosis and anatomical characterization of high-flow spinal CSF leaks caused by these osteophytes. This information allows for appropriate planning for percutaneous or surgical treatment.

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UTILIDAD DE LA CISTERNOGRAFÍA RADIOISOTÓPICA HÍBRIDA SPECT/CT 99MTC-O4--DTPA Y RMN EN EL DIAGNÓSTICO DE UN CASO DE HIPOTENSIÓN INTRACRANEAL ESPONTÁNEA: REVISIÓN DEL TEMA

SCIENTIARVM ◽

10.26696/sci.epg.0110 ◽

2015 ◽

Vol 1 (1) ◽

pp. 27-31

Author(s):

CARLOS CÁRDENAS ABARCA ◽

Keyword(s):

Spontaneous Intracranial Hypotension ◽

Definitive Diagnosis ◽

Csf Leak ◽

Anatomical Location ◽

Ct Cisternography ◽

Minimal Trauma ◽

Csf Leakage ◽

History Of ◽

Mechanical Factors ◽

Vertebral Osteophytes

Spontaneous intracranial hypotension (HIE) is an uncommon cause of secondary orthostatic headache, characterized by a decreased pressure and volume of cerebrospinal fluid (CSF), where dural quality and mechanical factors such as vertebral osteophytes play an important role, that after minimal trauma allow CSF leakage. We present the case of a 56-year-old male patient, who presented with severe postural headache, with a history of mild trauma at the level of the low thoracic spine with CSF pressure at the lower limit of normality, in whom radioisotopic SPECT/CT cisternography, provided the definitive diagnosis and exact anatomical location of the CSF leak, guiding treatment. A review of the pathophysiology, clinical presentation, diagnosis and treatment of HIE is carried out, emphasizing the diagnostic aid modalities, where hybrid imaging in nuclear medicine with SPECT/CT equipment allows a definitive diagnosis and management of HIE.

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Sensitivity of MRI of the spine compared with CT myelography in orthostatic headache with CSF leak

Neurology ◽

10.1212/01.wnl.0000435555.13695.22 ◽

2013 ◽

Vol 81 (20) ◽

pp. 1789-1792 ◽

Cited By ~ 20

Author(s):

A. Starling ◽

F. Hernandez ◽

J. M. Hoxworth ◽

T. Trentman ◽

R. Halker ◽

...

Keyword(s):

Orthostatic Headache ◽

Csf Leak ◽

Ct Myelography

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Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension

Journal of Neurosurgery ◽

10.3171/jns.1996.84.4.0598 ◽

1996 ◽

Vol 84 (4) ◽

pp. 598-605 ◽

Cited By ~ 238

Author(s):

Wouter I. Schievink ◽

Fredric B. Meyer ◽

John L. D. Atkinson ◽

Bahram Mokri

Keyword(s):

Cerebrospinal Fluid ◽

Thoracic Spine ◽

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Csf Leak ◽

Cervicothoracic Junction ◽

Ct Myelography ◽

Content Type ◽

Fine Print ◽

Csf Leaks

✓ Spinal cerebrospinal fluid (CSF) leaks are often implicated as the cause of the syndrome of spontaneous intracranial hypotension, but they have rarely been demonstrated radiographically or surgically. The authors reviewed their experience with documented cases of spinal CSF leaks of spontaneous onset in 11 patients including their surgical observations in four of the patients. The mean age of the six women and five men included in the study was 38 years (range 22–51 years). All patients presented with a postural headache; however, most had additional symptoms, including nausea, emesis, sixth cranial-nerve paresis, or local back pain at the level of the CSF leak. All patients underwent indium-111 radionucleotide cisternography or computerized tomographic (CT) myelography. The location of the spontaneous CSF leak was in the cervical spine in two patients, the cervicothoracic junction in three patients, the thoracic spine in five patients, and the lumbar spine in one patient. The false negative rate for radionucleotide cisternography was high (30%). Subdural fluid collections, meningeal enhancement, and downward displacement of the cerebellum, resembling a Chiari I malformation, were commonly found on cranial imaging studies. In most patients, the symptoms resolved in response to supportive measures or an epidural blood patch. Leaking meningeal diverticula were found to be the cause of the CSF leak in four patients who underwent surgery. In three patients these diverticula could be ligated with good result but in one patient an extensive complex of meningeal diverticula was found to be inoperable. Two patients had an unusual body habitus and joint hypermobility, and two other patients had suffered a spontaneous retinal detachment at a young age. In conclusion, spontaneous spinal CSF leaks are uncommon, but they are increasingly recognized as a cause of spontaneous intracranial hypotension. Most spinal CSF leaks are located at the cervicothoracic junction or in the thoracic spine, and they may be associated with meningeal diverticula. The radiographic study of choice is CT myelography. The disease is usually self-limiting, but in selected cases our experience with surgical ligation of leaking meningeal diverticula has been satisfactory. An underlying connective tissue disorder may be present in some patients with a spontaneous spinal CSF leak.

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Incidence of Spinal CSF Leakage on CT Myelography in Patients with Nontraumatic Intracranial Subdural Hematoma

Diagnostics ◽

10.3390/diagnostics11122278 ◽

2021 ◽

Vol 11 (12) ◽

pp. 2278

Author(s):

Hyo Jin Kim ◽

Joon Woo Lee ◽

Eugene Lee ◽

Yusuhn Kang ◽

Joong Mo Ahn

Keyword(s):

Subdural Hematoma ◽

Spontaneous Intracranial Hypotension ◽

Clinical Findings ◽

Csf Leak ◽

Age Group ◽

Ct Myelography ◽

Institutional Review ◽

Csf Leakage ◽

Age Range ◽

Csf Leaks

The aim of the present study was to demonstrate the incidence of spinal cerebrospinal fluid (CSF) leaks in patients with nontraumatic intracranial subdural hematoma (SDH) and determine clinical parameters favoring such leaks. This retrospective study was approved by the institutional review board. Patients diagnosed with nontraumatic intracranial SDH who underwent computed tomography (CT) myelography between January 2012 and March 2018 were selected. 60 patients (male: female, 39:21; age range, 20–82 years) were enrolled and divided into CSF leak-positive and CSF leak-negative groups according to CT myelography data. Clinical findings were statistically compared between the two groups. Spinal CSF leak was observed in 80% (48/60) of patients, and it was significantly associated with an age of <69 years (p = 0.006). However, patients aged ≥69 years also had a tendency to exhibit spontaneous intracranial hypotension (SIH)-induced nontraumatic intracranial SDH (60.87%; 14/23). Therefore, CT myelography is recommended to be performed for the evaluation of possible SIH in patients with nontraumatic intracranial SDH, particularly those aged <69 years. Patients aged ≥69 years are also good candidates for CT myelography because SIH tends to occur even in this age group.

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The utility of radioisotope cisternography in low CSF/volume syndromes compared to myelography

Cephalalgia ◽

10.1177/0333102416628467 ◽

2016 ◽

Vol 36 (13) ◽

pp. 1291-1295 ◽

Cited By ~ 7

Author(s):

Teshamae S Monteith ◽

Stephen F Kralik ◽

William P Dillon ◽

Randall A Hawkins ◽

Peter J Goadsby

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Csf Leak ◽

Ct Myelography ◽

Leak Location ◽

Perineural Cyst ◽

Mr Myelography ◽

Csf Leaks

Objective The objective of this report is to compare computed tomography (CT) and magnetic resonance (MR) myelography with radioisotope cisternography (RC) for detection of spinal cerebrospinal (CSF) leaks. Methods We retrospectively reviewed 12 spontaneous intracranial hypotension (SIH) patients; CT and RC were performed simultaneously. Three patients had MR myelography. Results CT and/or MR myelography identified CSF leaks in four of 12 patients. RC detected spinal leaks in all three patients confirmed by CT myelography; RC identified the CSF leak location in two of three cases, and these were due to osteophytic spicules and/or discs. RC showed only enlarged perineural activity. Only intrathecal gadolinium MR myelography clearly identified a slow leak from a perineural cyst. In eight remaining cases, the leak site was unknown; however, two of these showed indirect signs of CSF leak on RC. CSF slow leaks from perineural cysts were the most common presumed etiology; and the cysts were best visualized on myelography. Conclusion RC is comparable to CT myelography but has spatial limitations and should be limited to atypical cases.

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